Step 3: Address health literacy as a barrier to screening

This section covers the following steps:

Step 3.1 Encourage teach-back as standard practice

Step 3.2 Improve your organisational health literacy

What is health literacy?

Health literacy is more than the ability to just read words and numbers in the health setting. Health literacy is the ability to access, understand and act on health information.¹⁶

Health literacy should not be confused with intelligence.

Health systems are increasingly complex, requiring people to develop new skills to manage their rights and to make informed decisions.¹⁷
Even highly skilled people can find the health system too complex to understand, especially during periods of poor health or stress.¹⁷

It is for these reasons that the principle of universal precaution should apply:

Make health information and systems as easy to understand for all people, all of the time.

Health literacy is made up of both individual and organisational health literacy¹²:

Individual health literacy: The skills, knowledge, motivation and capacity of an individual to access, understand and act on health information.
Organisational health literacy is:
- how health professionals communicate
- how easy health systems are for people to use
- how easy it is for people to access, understand and act on health information and services.

Why is health literacy important?

60% of Australian adults do not have the level of health literacy needed to understand and use day-to-day heath information.¹⁸
Patients immediately forget 40% to 80% of the content from their medical encounters.¹⁹
The greater the amount of information presented, the lower the proportion correctly recalled.²⁰
Poor health literacy is a better predictor of low cancer screening knowledge than ethnicity or education; yet doctors infrequently recognise low health literacy.²¹
Those with low health literacy are¹⁷:
- less likely to use preventative services, such as cancer screening
- less likely to communicate concerns
- less likely to recognise significant disease early
- less likely to be adherent to treatment
- more likely to be hospitalised by a chronic condition
- more likely to use emergency services.

Taking action to improve health literacy

Step 3.1 Encourage teach-back as standard practice

Teach-back is a best practice communication method that focuses on the use of simple language and asking patients to ‘teach-back’ information to confirm understanding.

Teach-back can be used with all patients and helps patients to engage in their own care.¹⁶ Refresh your clinical team on the use of teach-back to support improved health literacy in your practice.

This short video from North Western Melbourne PHN is an excellent guide to the teach-back technique. Free online training is also available through www.teachbacktraining.org

“When I am at the Aboriginal Medical Service, staff explain things to me. They are good and tell me what is going on. At the hospital, if they tell me something, I don’t understand it (they use medical terms and jargon) and I feel “shamed” to ask because they say it once, but I don’t want to ask again because they think I’m dumb. So I say “yes” when they ask me if I know what they said.”36

- Aboriginal patient, Brisbane

Step 3.2 Improve your organisational health literacy

Step 3.2.1 Resources to support health literacy

The Australian Commission on Safety and Quality in Health Care website has a range of useful resources to support health literacy improvements in your practice. These include:

summary sheets on health literacy for clinicians and managers
health literacy infographics
fact sheets on:
tools and resources for patients to partner in their own health care, such as:

Step 3.2.2 Use low literacy educational resources

Using existing cancer screening resources designed for those with low literacy can be helpful. Existing resources include:

Bowel cancer screening:

Breast cancer screening

Family Planning NSW’s Being a healthy woman breast health fact sheet was designed to help people with intellectual disability understand breast health, but it is also a useful education tool for any patient with low health literacy.

Step 3.3 Routinely check the reading grade of written materials

The Flesch Kincaid Grade Level shows what level of education a person needs to read text.

Using the principle of universal precaution, your practice should aim for all written material to be between grade 6-8 on the Flesch Kincaid Grade Level.¹²

Simple text is easier for everyone to read but importantly, simple text will be understood by those with low health literacy.

Check the score of text.

The text below shows you an example of bowel screening information that is grade 10.45 and information that is grade 6.9. For many, the grade 10.6 text can be understood, but the grade 6.9 text will be understood by a broader audience.

Reading Grade 10.6

Reading Grade 6.9

The bowel screening test is a simple test that you do at home before sending samples to a pathology laboratory for analysis.

The test is quick, easy and painless. To increase the chances of detecting tiny amounts of blood in your bowel motion, you will need to take samples from two separate bowel motions.

Ideally, samples should be collected as close together as possible and preferably no more than 2-3 days apart.

The National Bowel Screening Programme test detects tiny traces of blood present in a small sample of your bowel motion (poo).

This may be an early warning sign that something is wrong with your bowel.
The free test is quick, clean and simple to do by yourself at home. Your test kit comes with instructions and a consent form.

These videos give a step-by-step explanation of how to do the test.